According to the CDPH, there have been a total of 18 deaths so far - all in the San Diego area, which has reported 490 cases of hepatitis A and 342 hospitalizations.

The CDPH said the Santa Cruz area has 71 reported cases and 33 hospitalizations; Los Angeles has 8 reported cases and 6 hospitalizations; and other regions in California have 7 reported cases and 5 hospitalizations.

This brings the total number of cases in the state to 576 with 386 hospitalizations.

California is experiencing the largest hepatitis A outbreak in the United States transmitted from person to person - instead of by contaminated food - since the vaccine became available in 1996.

According to the CDPH, the hepatitis A virus is spread when the virus is ingested by mouth from contact with hands, objects, food or drinks that are contaminated by the feces of an infected person.

Hepatitis A infection typically causes fever, a general ill feeling, yellowness of the skin, lack of appetite and nausea. Severe hepatitis A infection is rare but is more common in people with underlying liver disease and can cause the liver to fail, which can lead to death.

For more information about preventing Hepatitis A, visit the Centers for Disease Control and Prevention website at www.cdc.gov/vaccines/vpd/hepa.